Fill out Form 1099-SA (Distributions From an HSA, Archer MSA, or Medicare Advantage MSA) online
Form 1099-SA reports distributions made from a Health Savings Account (HSA), Archer Medical Savings Account (MSA), or Medicare Advantage MSA during the year. It shows the total distribution amount and indicates whether the distribution was a normal distribution, an excess contribution withdrawal, or a disability or death distribution.
How to fill out Form 1099-SA (Distributions From an HSA, Archer MSA, or Medicare Advantage MSA)
Enter trustee and recipient information
Fill in the trustee's or custodian's name, address, phone, and TIN. Enter the account holder's name, address, and TIN.
Report distribution amounts
Enter the gross distribution amount in Box 1. Enter the earnings on excess contributions in Box 2 if the distribution includes a return of excess contributions.
Identify the distribution type
Enter the distribution code in Box 3: 1 for normal distribution, 2 for excess contributions, 3 for disability, 4 for death, or 5 for prohibited transaction. Check Box 4 if the distribution is from an Archer MSA and Box 5 if from a Medicare Advantage MSA.
File and distribute copies
File Copy A with the IRS by the filing deadline. Provide Copy B to the account holder. Retain Copy C for your records. The account holder uses this form with Form 8889 to report HSA activity on their tax return.
About Form 1099-SA (Distributions From an HSA, Archer MSA, or Medicare Advantage MSA)
Who needs this form
Trustees or custodians of HSAs, Archer MSAs, or Medicare Advantage MSAs who made distributions during the year must file this form. Account holders receive a copy to determine the taxable portion of their distributions when filing their tax return.
Where to submit
Trustees file Copy A with the IRS by the applicable IRS filing deadline for the filing year. Provide Copy B to the account holder by the deadline listed in the latest official instructions.
Source and content freshness
- Reviewed: 2026-02-24
- Filing deadlines may shift for weekends and holidays. Verify due dates with official instructions.
Common mistakes to avoid
- Not matching HSA distributions with qualified medical expenses, resulting in unexpected taxable income
- Confusing Form 1099-SA (distributions) with Form 5498-SA (contributions)
- Failing to report distributions used for non-qualified expenses as taxable income plus the 20% penalty
- Not keeping receipts for qualified medical expenses to substantiate tax-free HSA distributions
Got any questions?
Is this form free to fill out?
Do I need to create an account?
Is my data secure?
Is this legal, tax, or immigration advice?
Can I share a direct link to this form?
Are all HSA distributions taxable?
SimplePDF provides a tool to fill out PDF forms. We are not affiliated with any government agency or form issuer. It is your responsibility to verify the accuracy and completeness of any information entered. SimplePDF is not liable for errors, omissions, or consequences resulting from the use of filled-out forms.